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HomeMy WebLinkAboutMiscellaneous - 148 MAIN STREET 4/30/2018 (2) .� `� J� 1 Date...."-::.....'.......V......... f ,kORT11 1 r°•`�`" "°O� TOWN OF NORTH ANDOVER o PERMIT FOR WIRING ACMUS This certifies that has permission to perform ............................a ............................................. wiring in the buildingof.........., <_ %.......................................................... at.:/ .......................... '..-. ...��4/............ .North Andover,Mass. Fee..................... Lic.No, .... 1 L..... : A.e�........................ ELECTRICALJN§PECTOR Check # -� U 56L" 0 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTIO REGULATIONS Occupancy and Fee Checked [Rev. 11/991 leave blank APPLICATION FOR P MIT TO PERFORM ELECTRICAL WORK All work to be performed in cordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK ORE ALL IN O TION) Date: —/,2—0 City or Town of: f d✓ To the Inspector of Wires: By this application the undersigned es notice of his or her intention to perform the electrical work described below. Location(Street&Number) Al ( t?2/4-Ity S T' &-101 (p!72 Owner or Tenant Vtb(,'L j 9tQ'l(0 Telephone No. j y� -O k'6;1— Owner's '6;1—Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Q Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Y Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the ollowin table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets l No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above ❑ In- ❑ o.o Emergency ig ing rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones ` No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers / Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Water No.of No.of No.of Devices or Equivalent Heaters KW Data Wiring: Signs Ballasts f Devices or Equivalent ITeleco unications Wiring:No.Hydromassage Bathtubs No.of Motors Total HPNoof Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE X BOND ❑ OTHER ❑ (Specify:) On File Feb/Zoo(p Estimated Value of Electrical Work:�7.00 __11 (When required by municipal policy.) (Expiration Date) Work to Start: 2--/0 Of Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: Kelly M.Casey Signature LIC.NO.: 37200 (If applicable,enter "exempt"in the license number line) Bus.Tel.No.: 978-697-4453 Address: 700 Robbins Ave Unit 3 Dracut,Mass 01826 Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ oZ r 00